medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-9-80-93medsovet-5707Research ArticleОПУХОЛИ КОЖИSKIN TUMORSПодходы к терапии метастатической меланомы кожи в 2020 году: динамичное движение впередApproaches to metastatic skin melanoma therapy in 2020: a dynamic way forwardhttps://orcid.org/0000-0001-7150-5071СамойленкоИ. В.SamoylenkoI. V.

Самойленко Игорь Вячеславович, к.м.н., старший научный сотрудник отделения онкодерматологии

115478, Москва, Каширское шоссе, д. 24

Igor V. Samoylenko, Cand. of Sci. (Med.), senior researcher of the Department of Oncodermatology

24, Kashirskoye Shosse, Moscow, 115478

i.samoylenko@ronc.ruhttps://orcid.org/0000-0002-8562-6082ДемидовЛ. В.DemidovL. V.

Демидов Лев Вадимович, д.м.н., профессор, заведующий отделением онкодерматологии

115478, Москва, Каширское шоссе, д. 24 

Lev V. Demidov, Dr. of Sci. (Med.), Professor, head of the Department of Oncodermatology

24, Kashirskoye Shosse, Moscow, 115478

l.demidov@ronc.ruНациональный медицинский исследовательский центр онкологии им. Н.Н. БлохинаРоссияN.N. Blokhin National Medical Research Center of OncologyRussian Federation202028072020098093Copyright © Самойленко И.В., Демидов Л.В., 20202020Самойленко И.В., Демидов Л.В.Samoylenko I.V., Demidov L.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5707

Выбор терапии первой линии метастатической меланомы кожи в последние несколько лет стал довольно непростой задачей: у практикующего онколога появились лекарственные препараты различных классов с различным механизмом действия – блокаторы иммунных чек-пойнтов и ингибиторы тирозинкиназ BRAF/MEK. В данной работе авторы постарались систематизировать собственный опыт и текущие научные сведения о лечении больных метастатической меланомой кожи в первой и последующих линиях терапии. В работе обсуждается важность правильной исходной оценки состояния пациента и распространенности процесса, роль доступных в настоящее время биомаркеров при метастатической меланоме кожи, а также эффективность и безопасность возможных вариантов первой линии терапии данного заболевания. Ввиду отсутствия данных прямого сравнения комбинированной иммунотерапии, комбинированной таргетной терапии, тройной комбинации блокаторов BRAFi + MEKi + aPDl1 и монотерапии aPD1, полученных в результате рандомизированных исследований, нам приходится проводить параллели между исследованиями с различными диагнозами и различными популяциями пациентов. Поскольку практикующему онкологу в своей ежедневной работе приходится выполнять те же действия, мы полагаем, что наш обзор будет для этих врачей весьма полезен. В статье также обсуждаются возможности применения лекарственной терапии во второй и последующих линиях и успешная в ряде случаев стратегия возврата к предыдущему лечению. В качестве иллюстрации успеха тактики последовательной терапии различными препаратами приводится клиническое наблюдение пациентки с метастатической меланомой кожи стопы, которая наблюдается в нашем отделении с 2010 г. Клиническое наблюдение демонстрирует успех возврата к некоторым, ранее уже применяемым линями терапии, в т. ч. после развития прогрессирования на них.

The choice of first-line therapy for metastatic skin melanoma has become quite a difficult task in the last few years: a practicing oncologist has got drugs of different classes with different mechanisms of action – immune checkpoint blockers and BRAF/MEK tyrosine kinase inhibitors. In this study, the authors have tried to systematize their own experience and current scientific information about the treatment of patients with metastatic skin melanoma in the first and subsequent lines of therapy. The paper discusses the importance of correct initial assessment of the patient’s condition and prevalence of the process, the role of currently available biomarkers in metastatic skin melanoma, as well as the effectiveness and safety of possible first-line therapy options for this disease. Due to the lack of data for direct comparison of combined immunotherapy, combined targeted therapy, triple combination of BRAFi + MEKi + aPDl1 blockers and aPD1 monotherapy obtained from randomized studies, we have to draw parallels between studies with different diagnoses and different patient populations. Since the practicing oncologist has to do the same thing in his or her daily work, we believe that our review will be very useful for these doctors. The article also discusses the possibility of using drug therapy in the second and subsequent lines and a successful strategy to return to previous treatment in some cases. The clinical observation of a patient with metastatic foot skin melanoma, which has been observed in our department since 2010, is given as an illustration of the success of sequential treatment tactics with different drugs. Clinical observation shows the success of returning to some previously used therapy lines, including after the progression on them.

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The authors declare that there are no conflicts of interest present.